EP3046632B1 - Compositions d'hygiène buccale - Google Patents

Compositions d'hygiène buccale Download PDF

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Publication number
EP3046632B1
EP3046632B1 EP14777917.7A EP14777917A EP3046632B1 EP 3046632 B1 EP3046632 B1 EP 3046632B1 EP 14777917 A EP14777917 A EP 14777917A EP 3046632 B1 EP3046632 B1 EP 3046632B1
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Prior art keywords
oral
subjects
halitosis
nitrates
oral hygiene
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German (de)
English (en)
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EP3046632A1 (fr
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Willem CRIELAARD
Martijn BRUGMAN
Ronald Hendrik Peter Brus
Bart KLEIN
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GLYMUR BV
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GLYMUR BV
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/19—Cosmetics or similar toiletry preparations characterised by the composition containing inorganic ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/17—Amides, e.g. hydroxamic acids having the group >N—C(O)—N< or >N—C(S)—N<, e.g. urea, thiourea, carmustine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/02—Ammonia; Compounds thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A61K33/40—Peroxides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K8/00—Cosmetics or similar toiletry preparations
    • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
    • A61K8/30—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds
    • A61K8/40—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds containing nitrogen
    • A61K8/42—Amides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61Q—SPECIFIC USE OF COSMETICS OR SIMILAR TOILETRY PREPARATIONS
    • A61Q11/00—Preparations for care of the teeth, of the oral cavity or of dentures; Dentifrices, e.g. toothpastes; Mouth rinses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2800/00—Properties of cosmetic compositions or active ingredients thereof or formulation aids used therein and process related aspects
    • A61K2800/74—Biological properties of particular ingredients

Definitions

  • the invention relates to compositions and their use for improving the health of the oral cavity in animals and humans. More in particular, the invention relates to such compositions and their use to treat and/or prevent halitosis.
  • Halitosis (bad breath) constitutes an underestimated problem.
  • the problem of bad breath not only hampers an individual in its social life, it is also a sign of poor oral hygiene, with potentially more severe health implications.
  • VSC volatile sulphur compounds
  • H2S Hydrogen sulphide
  • CH3SH methyl mercaptan
  • CH3SCH3 dimethyl sulphide
  • VSC volatile sulphur compounds
  • the most common strategy used in the treatment of halitosis is killing the bacterial population inside the oral cavity using mouth wash compositions that comprise antibacterial compounds.
  • WO0174322A1 discloses oral hygiene compositions comprising the cationic antibacterial agent, chlorhexidine, for combating halitosis.
  • Listerine® is the trademark for an antiseptic solution containing boric acid, benzoic acid, thymol, and essential oils of Eucalyptus, Gaultheria, sorbitol solution, 21.6 percent alcohol, Poloxamer 407, benzoic acid, flavoring, sodium saccharine, sodium citrate, citric acid and colorant.
  • compositions for the treatment of periodontal disorders including halitosis.
  • the compositions consist of a mixture of hydrogen peroxide, eugenol, permonochlorophenol, camphor, maltitol, coloring matter and appetizing substance water.
  • compositions comprising highly hydrophobic compounds, such as hydrocarbons, vegetable and/or mineral oils. By binding to the outer surface of bacteria, these are effectively removed from the oral cavity and from the surface of teeth.
  • the compositions are stated to be effective in the removal of odor-forming constituents and thus for the alleviation of or removal of the effects of halitosis.
  • US2004067204A discloses the use of antioxidants or antioxidant-containing compositions for treating halitosis, such as vitamins, coenzyme Q,amino acids, imidazoles, peptides, fatty acids, metal compounds and derivatives of these compounds (for example salts, esters, ethers, sugars, nucleotides, nucleosides).
  • antioxidants or antioxidant-containing compositions for treating halitosis such as vitamins, coenzyme Q,amino acids, imidazoles, peptides, fatty acids, metal compounds and derivatives of these compounds (for example salts, esters, ethers, sugars, nucleotides, nucleosides).
  • mouth rinses those that comprise quaternary amines (e.g., combinations of ethanol and domiphen bromide and/or cetylpyridinium chloride) or mixtures of orally acceptable surface-active agents or surfactants.
  • quaternary amines e.g., combinations of ethanol and domiphen bromide and/or cetylpyridinium chloride
  • surface-active agents or surfactants e.g., combinations of ethanol and domiphen bromide and/or cetylpyridinium chloride
  • cationic agents such as chlorhexidine digluconate, metallic fluoride salts such as stannous fluoride, antimicrobial essential oils (e.g., thymol, eucalyptol, ethanol, menthol and methyl salicylate) and/orwater-insoluble phenolic agents such as triclosan.
  • Cationic antimicrobial materials such as chlorhexidine, benzethonium chloride, and cetyl pyridinium chloride have been investigated as antimicrobial agents in compositions for the control of gingivitis and/or halitosis.
  • the antimicrobial activity of these compounds is most probably connected to the positive charge of these molecules. Because of their positive charge these compounds are attracted to negatively-charged moieties on the cell membrane or wall of the microorganism, which facilitates attachment to the surface of the microorganism. The attachment and subsequent interaction with the cell surface disrupts the cell membrane structure causing leakage of the intracellular fluids, eventually killing the microorganism.
  • US2005239903A discloses compositions for the treatment of halitosis using phenyl substituted phenol compounds exhibiting antimicrobial activity, antimicrobial compositions containing phenyl substituted phenol compounds, and methods of using such compositions.
  • WO11094872A1 discloses liquid oral care compositions, particularly in the form of a mouth spray or gurgling rinse, comprising non-ionic surfactants, flavoring oils and precursors of ClO2.
  • CN102218021A discloses a toothpaste for treating halitosis, which comprises by weight percentage: 20 to 30 percent of calcium carbonate, 20 to 30 percent of silicon dioxide, 10 to 15 percent of sorbierite, 10 to 15 percent of glycerol, 1.0 to 2.0 percent of naringin, 1.0 to 2.0 percent of zinc citrate, 0.1 to 0.2 percent of cineole, 1.5 to 2.0 percent of laurinol sodium sulfate, 0.5 to 1.0 percent of hydroxymethyl sodium cellulosate, 1.0 to 2.5 percent of sodium saccharin, 1.0 to 1.5 percent of essence, dissolved in water.
  • DE102007050767A1 discloses anti-bacterial and bleaching oral care and treatment compositions, also against halitosis, which rely on peroxides like UHP for treating halitosis.
  • water-soluble salts of certain metals such as divalent cations of zinc, copper and tin, can inhibit oral malodor.
  • the metals mentioned above have high affinity for sulfur and eliminate the VSC by forming insoluble sulfur compounds, which inhibits further formation of the odoriferous gases in the oral cavity.
  • Water soluble, cationic, antibacterial agents such as the bis-biguanides and the quaternary ammonium compounds are reportedly able to inhibit oral malodor when used as mouth rinses.
  • Japanese Patent Application JP 1996/356310 Publication JP 98182384 A2 discloses a composition which can be used for the prevention of bad breath, comprising triclosan, sodium bicarbonate, menthol and other fragrances.
  • Japanese Patent Application JP 1988/317621 (Publication JP 90164816 A2 ) relates to an aqueous composition containing ferrous sulfate and sodium bicarbonate for treating halitosis.
  • Japanese Patent Application JP 1985/39538 ( Publication JP 86197510 A2 ) relates to a composition in the form of a toothpaste, tooth powder, mouthwash, gingival massage cream or local liquid or a paste paint, containing nitroimidazole and extracts from leaves of camellia plant such as tea tree or camellia or sodium copper-chlorophyllin.
  • the composition is used for the prevention of periodontal diseases and reportedly inhibits gram negative, anaerobic microorganisms from forming volatile sulfur compounds in the oral cavity.
  • WO 99/56714 relates to a bactericide for detergents which comprises an inorganic support having antifungal metal ions supported thereon, and a denture detergent containing the bactericide.
  • the bactericide is specifically intended for dentures and it is stated that it suppresses bad breath and denture-specific stomatitis.
  • GB2381449A discloses oral hygiene compositions suitable for the treatment of halitosis and periodontal disease comprising a nitro-containing antibacterial compound, such as the nitrofurans nitrofurantoin and nitrofurazone and the 2-, 4- or 5-nitroimidazoles benzimidazole, nimarozole, tinidazole and metronidazole.
  • the compositions may be in various forms, including as a dentifrice, a mouthwash, a gel or a solid matrix.
  • Another strategy in combating halitosis is to add compounds that aid in complexation and/or degradion of VCS.
  • Canadian patent application no. 2,154,860 relates to an oral care product which contains alkali metal pyrophosphate and a water-soluble zinc polyamine complex capable of releasing zinc ions in an environment such as the oral cavity.
  • US2012148506A discloses a poly-antiseptic antimicrobial pharmaceutical composition for oral use, for the hygiene and treatment of oral diseases of bacterial etiology, including halitosis, consisting of a mixture of hydrogen peroxide, eugenol, natural camphor, zinc sulphate, sodium fluoride, xylitol, cetylpyridinium chloride and excipients.
  • KR20030072766A discloses an oral hygiene composition containing chlorite ions encapsulated in a liposome and zinc ion.
  • the composition can extend the remaining time of chlorite ions which can chemically decompose volatile sulfur compounds within the oral cavity.
  • Yet another strategy in treating halitosis concerns the provisioning of mutant bacteria, as a probiotic.
  • US2006246015A discloses compositions comprising one or more isolated LDH-deficient mutant streptococcus strains and one or more isolated S. oralis strains and/or one or more isolated S. uberis strains.
  • the prior art predominantly advocates the use of antibacterials as a way of treating halitosis
  • the present inventors consider such use of antibacterials to be a major disadvantage of the mouth hygiene compositions of the prior art.
  • the antibacterials used in the mouth wash compositions of the prior art are indiscriminate in that they kill, or at least decimate, the entire mouth flora, including the bacterial species that are important for oral cavity health.
  • the invention in one aspect provides an undiluted oral hygiene composition
  • said undiluted oral hygiene composition comprises 30 - 75% nitrates, more preferably 40 - 70% nitrates, still more preferably 50 - 65% nitrates.
  • Said undiluted oral hygiene composition preferably comprises as other nitrates at least ammonium nitrate and optionally potassium nitrate.
  • the invention provides a diluted oral hygiene composition obtainable by diluting an undiluted oral hygiene composition according to the invention with water, or some other diluents compatible with it, wherein the dilution factor is selected from the group consisting of a between 1:1 and 1:10, between 1:10 and 1:50, between 1:50 and 1:00 and between 1:100 and 1:1000.
  • the invention provides an oral hygiene composition according to the above, for the use in the treatment and/or prevention of halitosis in a human or animal.
  • a composition is provided that is rich in nitrates, according to claim 1 for use in the treatment and/or prevention of halitosis in a human or animal.
  • Said composition is one, wherein said nitrates make up 20 - 80 % of the composition, wherein at least half the amount of nitrates consists of calcium nitrate, the remainder of the nitrates being selected from any ammonium nitrate, potassium nitrate or any pharmaceutically acceptable cation salt thereof.
  • Said composition further comprises UHP and optionally urea.
  • Said composition is preferably for oral administration to a subject in need thereof, but other ways of administration are not excluded.
  • the present invention provides mouth hygiene compositions that reduce VSC by changing the growth conditions in the oral cavity in favor of anaerobic respiration.
  • Anaerobic respiration is a form of respiration that involves electron acceptors other than oxygen. Examples of such alternative electron acceptors are sulfates, nitrates, sulfur and fumarate.
  • a shift towards anaerobic respirational growth of the microflora in the oral cavity is brought about using an oral hygiene composition that is rich in nitrates.
  • Such compositions considerably reduce the production of VSC compounds, especially hydrogen sulfide.
  • US2009324547A discloses an oral composition comprising a combination of probiotic bacteria selected from the group comprising Streptococcus, Eubacterium, Neisseria, Veillonella and pH-rising and/or buffering components, which re-establishes an oral microflora associated with good oral health in subjects with a disturbed oral microflora.
  • the invention also discloses the use of the oral composition in combination with other oral health promoting products to help subjects suffering from disorders such as oral dryness, caries, halitosis, inflamed oral mucous membranes or oral fungal infections to restore good oral health.
  • the object of the inventors in US2009324547 may be similar, the approach chosen is an entirely different one.
  • the mouth flora composition is not altered by adding bacteria from the outside, but by changing the conditions that determine the composition of the mouth flora.
  • the invention does so, by stimulating anaerobic respirational growth by adding a composition that comprises a number of components that favor the growth of bacteria capable of anaerobic respirational growth, at the expense of strict anaerobic bacteria that are responsible for the formation of VSC.
  • the invention provides mouth hygiene compositions rich in nitrates, such as ammonium nitrate and especially calcium nitrate.
  • nitrates such as ammonium nitrate and especially calcium nitrate.
  • Sodium nitrate, potassium nitrate, and magnesium nitrate may be present,but they are not essential.
  • Preferred nitrates in compositions according to the invention are calcium nitrate and ammonium nitrate.
  • the mouth hygiene composition according to the invention provides hydrogen peroxide - urea, also known as urea peroxide, percarbamide, carbamide peroxide or simply as UHP (hereinafter UHP), and optionally creatinine.
  • UHP hydrogen peroxide - urea
  • Preferred according to the invention are compositions rich in calcium nitrate and UHP.
  • the nitrate ions are believed to be important components in the oxidation pathway of aerobic and facultative bacteria in an anaerobic environment.
  • Each of the anions in the nitrate salt primarily Ca++and NH4+ (and optionally K+) serve their own purpose and are believed to be important. Although the presence of all three is preferred, the presence of all three is not essential.
  • the calcium ion when added to the halitotic oral cavity with its typically higher sulfide composition, will precipitate out calcium sulfate. This lowers the amount of sulfate ions available to anaerobic bacteria as their oxidant source. Combined with the addition of the nutrient source for oxidation, this compound plays an important role in ensuring that the bacteria capable of anaerobic respirational growth out-compete the strictly anaerobic bacteria. Calcium is also a source of nutrition for cell development in bacteria. In addition, the precipitation of sulfate formed from sulfide will directly contribute to a reduction of VSC and thereby directly reduce the symptoms of halitosis.
  • Potassium is an important building block for cell nutrition and growth.
  • the potassium ion is a preferred component of the composition according to the invention, as it provides for selective growth promotion of bacteria capable of anaerobic respirational growth.
  • ammonium ion functions as an electron donor in the respiratory path of anaerobic respiring bacteria. It is therefore believed to contribute to the selective growth promotion of such bacteria in the oral cavity.
  • Micro-organisms such as bacteria require a carbon source for protein synthesis.
  • the composition according to the invention provides such a carbon source in addition to nutrients for the anaerobically respiring bacteria that use nitrate as their respiratory oxidant.
  • UHP and/or urea effectively and selectively stimulates the growth of such bacteria in the oral cavity.
  • Urea in addition to UHP is preferred but not essential.
  • the composition according to the invention in undiluted form comprises between 20 and 80 percent calcium nitrate, preferably between 30 and 75%, most preferably between 40 and 70%, still more preferably between 50 and 65%.
  • the composition according to the invention comprises between 5 and 30 % UHP, more preferably between 10 and 25%, still more preferable between 15 and 20% UHP.
  • the composition according to the invention comprises between 0 and 20% urea, more preferably between 2 and 15%, still more preferably between 5 and 10% urea.
  • a fraction of totality of the nitrates salts is in the form of ammonium nitrate and/or potassium, preferably both.
  • the presence of sodium nitrate is entirely optional.
  • the components should make up 100% together with a minimum of water. Calcium nitrate is extremely soluble in water. In fact the composition according to the invention is difficult to obtain in dry form as it tends to attract water and become a solution more or less spontaneously.
  • Most preferred according to the invention is a composition comprising in undiluted form between 60 and 65% Calcium nitrate, between 15 and 20% UHP and between 5 and 10% urea, the remainder being water adding up to 100%.
  • Oral hygiene compositions according to the invention may be sold and used in undiluted form.
  • the oral hygiene composition may be sold and used in diluted form.
  • Useful dilutions are for example dilutions between 1:1 and 1:1000, preferably 1:100, still more preferably 1:50, even more preferably 1:10.
  • the end user may dilute the oral hygiene composition by adding water or some other fluid that is compatible with the oral hygiene composition according to the invention or its intended use.
  • Oral hygiene compositions of the present invention maybe provided in any of the presentations normally used for such products, for instance, dentifrices including toothpastes and toothpowders, abrasive and non-abrasive gels, mouthwashes, gargles, irrigating solutions, mouth sprays and presentations for sucking or chewing by the user such as gums, pastilles, lozenges and wafers which can rapidly dissolve in the mouth.
  • dentifrices including toothpastes and toothpowders, abrasive and non-abrasive gels, mouthwashes, gargles, irrigating solutions, mouth sprays and presentations for sucking or chewing by the user such as gums, pastilles, lozenges and wafers which can rapidly dissolve in the mouth.
  • Components for the orally acceptable carrier or excipient will be selected according to the particular type of presentation involved.
  • the pH of the composition is preferably compatible with oral tissues, typically between 4 and 9, more preferably between 5 and 8.
  • the composition can optionally include non-active additives to enhance the appearance or taste of the composition, for example, and coloring and/or, flavoring agents as are known in the art.
  • non-active additives include the mint-flavorings such as oil of spearmint, oil of peppermint and oil of wintergreen, and other oils including citrus, clove, eucalyptus, etc.
  • Colorants may be chosen from those approved by the FDA, such as Blue Nos. 1 and 2. Green No. 6, Red Nos. 3 and 40, and Yellow Nos. 5 and 6.
  • Non-fermentable sugars or sugar substitutes may also be added where a sweetened vehicle is desired.
  • Flavorants and sweeteners are used in small amounts, e.g., up to 0.25 weight percent, preferably up to 0.05 weight percent.
  • Known anti-stain additives e.g., in an amountof 0.01 to 0.1 weight percent, may also be added, such as phosphorous-containing and organo-phosphorous-containing compounds.
  • phosphorous-containing and organo-phosphorous-containing compounds may also be added, such as phosphorous-containing and organo-phosphorous-containing compounds.
  • both a mouth rinse and a tooth brushing with the composition of the invention are undertaken in the morning, while in the evening, the mouth rinse alone is used.
  • the composition can always be used in mouthwash form alone.
  • oral hygiene compositions these will be understood to include at least one component not typically present in products rich in nitrates and UHP and used or promoted for waste water treatment, agricultural or industrial use, or similar non pharmaceutical or cosmetic treatments.
  • Such components may be selected from colorants, flavorants, fragrances, sweeteners and texture improvers, such as gels (carrageenans) and the like.
  • compositions according to the invention stimulate bacteria to use electron acceptors other than oxygen, such as nitrates, sulphates, sulfur or fumarate. This process is referred to in the literature as anaerobic respiration.
  • the compositions according to the invention are rich in nitrates, stimulating bacteria to use nitrates as electron acceptor under anaerobic conditions.
  • the compositions according to the invention when administered to a subject in need thereof, preferably orally, stimulate nitrate reduction.
  • the concomitant production of nitrite from nitrate is believed to have several medical benefits associated with it. For example, nitrite is considered to be required for the production of NO, which is regulator of blood pressure. These and other medical benefits are considered to be part of the invention.
  • the compositions according to the invention are also useful as a medicament, not just for treating halitosis, but for treating other disorders such as high blood pressure and the like.
  • halitosis and other disorders associated with the oral cavity are all encompassed by the invention, regardless whether such treatment is on medical indication or by way of cosmetic treatment.
  • compositions according to the invention were tested for their effect on the bacterial growth, bacterial diversity and the formation of VSC in the oral cavity of humans, we took dilutions of BM500TM a commercially available product (A Blue World Company B.V.) rich in nitrates and UHP and tested them in a biofilm model developed at ACTA (Amsterdam).
  • the ACTA biofilm model system ( Exterkate et al, Caries Research 2010 Vol 44 (4) p372-379. 2010 ) was used as a basis for these experiments. Briefly, sterile microscope-glass-slides mounted on a stainless steel lid, were suspended in a 24-well microtiter plate containing a saliva derived inoculum.
  • Stimulated saliva was diluted 50-fold in the inoculation medium consisting of 2.5 g/l mucin, 2.0 g/l Bacto peptone, 2.0 g/l Trypticase peptone, 1.0 g/l yeast extract, 0.35 g/l NaCl, 0.2 g/l KCl, 0.2 g/l CaCl 2 , 1 mg/l hemin, and 0.2 mg/l vitamin K1 according to McBain et al Journal of Applied Microbiology (2005) 98:p624-634 , at pH 7.0.
  • the glass-slides were transferred to a 24-well plate containing fresh medium without inoculum and incubated at the same conditions for another 16 h.
  • the slides were subsequently moved to a 24-well plate containing fresh medium with the addition of a tenfold diluted active compound to final concentrations of either 2000, 1000, 100, 25, 10 and 1 ppm BM500, 10% Listerine, 10% and 4% and 0.2% CB12 and MilliQ water as a negative control.
  • the glass slides were incubated for an additional 48 hrs under anaerobic conditions at 37°C with media refreshments, containing the active compounds, at 8, 24 and 32 hours.
  • the 72 hrs microcosm biofilms were harvested, by removing the glass slides from the stainless steel lids, and transferred to sterile tubes containing cysteine peptone water. The glass sides were subsequently sonicated, serially diluted and plated onto tryptic soy blood agar, followed by an incubation for 72 hours at 37°C under anaerobic condition. The bacterial viability was determined by counting the amount of colony forming units (CFU) per plate and correcting them for the proper dilutions.
  • CFU colony forming units
  • BM500 does not affect the viability of 72hr grown microscosm biofilms at concentrations up to 100 ppm BM100 and even seems, although not statistically significant, to promote the growth of bacteria.
  • the control products Listerine (R) and CB12 reduce the bacterial viability by respectively 50 and more than 99%.
  • Figure 2 shows the effect of 1000 and 2000 ppm BM 500 and 500 times diluted CB12 (equivalent to 2000 ppm) on the viability of 72 hours microcosm biofilms of two different saliva donors; viability does not seem to be affected.
  • bacterial halitosis biofilms were grown in glass-GC-vials over five days.
  • the GC-vials were inoculated with a saliva derived inoculum from four different donors.
  • the media composition was similar to the bacterial viability assay.
  • the vials were closed airtight and were incubated at 37°C for 24 hours. After 24 hours the medium was refreshed with McBain medium containing either 1000, 2000 ppm BM500 or water as a negative control.
  • the biofilms were allowed to grow under the same environmental conditions for an additional 96 hr, with a medium refreshment each 24 hours. We have varied the growth conditions by adding BM500TM in 1000 and 2000 ppm to the media.
  • VSC volatile sulphur compound
  • a 0.5 ml gas sample was taken from the GC vial and diluted with ambient air to quantifiable amounts.
  • the biofilms were harvested and DNA was isolated.
  • a PCR was performed using primers that will lift out a fragment of the bacterial 16S rDNA-gene. This gene is used for bacterial phylogeny. 16S rDNAfragments were separated and visualized using a Denaturing Gradient Gel Electrophoresis (DGGE) experiment.
  • DGGE Denaturing Gradient Gel Electrophoresis
  • This DGGE analysis will give insight in the diversity of the samples; the treatment should not lead to biofilms with a low diversity, i.e. select for only specific species. DGGE will also give insight in similarities/differences between the bacterial community profiles of the samples; the hypothesis is that the treatment(s) will lead to a different bacterial community/different (nitrate reducing instead of VSC producing) species.
  • the organoleptic scoring showed that biofilms treated with various concentrations of BM500 indeed produce markedly reduced VSC.
  • the Oral Chroma measurements confirmed ( figure 3 ) that the application of BM500 reduced the amount of H2S.
  • the amount of methyl mercaptane could not be determined using the Oral Chrome measurement.
  • the amounts were below the detection limit of the Oral Chrome detection kit.
  • the Oral Chrome measurement could neither confirm nor refute that methyl mercaptane was reduced. Reduction of methyl mercaptane should be confirmed using gas chromatography.
  • Halitosis biofilms after the second medium refreshment were incubated in growth medium supplemented with different concentrations of BM500TM. These concentrations BM500TM were subsequently kept in the growth medium until the end of the growth experiment.
  • DGGE phosphate buffer saline
  • the numbers in these primers reflect the positions in the bacterial 16s rDNA where they hybridize.
  • Amplification was performed using Taq polymerase and a Biometra thermocycler (PCR machine) and yielded copies of the different bacterial 16S genes that were used for profiling.
  • DGGE was performed with the Bio-rad DCode system.
  • the 16S PCR product was loaded onto 1-mm thick 8% (w/v) polyacrylamide (ratio of acrylamide to bisacrylamide, 37.5:1) gels containing a 30-70% linear denaturing gradient.
  • a marker consisting of bacterial reference strains was added at both sides of each gel, as well as after every four samples. The gels were run at 40 V for 16 h, stained using ethidium bromide and recorded with a charge-coupled device camera system.
  • Microbial diversity is the variation in microbial species in an ecosystem.
  • diversity indices are calculated statistically.
  • a frequently used index is the Shannon Weaver index of general diversity (H').
  • H' takes into account the number of DGGE bands and the relative contribution of each band to the whole set of bands. Band positions will be assigned manually. The individual bands and their intensities in the community profiles will be determined using GelCompar software. A higher H' indicates a higher diversity. Similarities (and hence also differences) between DGGE profiles will be calculated using GelCompar software by Pearson product-moment correlation coefficient and visualised using the Unweighted Pair Group Clustering Method with Arithmetic Averages (UPGMA).
  • UPMA Unweighted Pair Group Clustering Method with Arithmetic Averages
  • Figures 4a and 4b show the DGGE profiles from microcosm derived from four different saliva's (in duplo) grown under either 0, 1000 and 2000 ppm BM500.
  • the samples show a shift in the microbial composition after treatment with 1000 or 2000 ppm BM500 as compared to the negative controls.
  • black and white were inverted in Figures 4a and 4b .
  • Study population 20 systemically healthy human volunteers, 18 - 55 yr old with halitosis as determined by organoleptic score.
  • One group of 10 volunteers will rinse with BM500 (10 mL for 30 seconds) 3 times a day for a duration of 14 days and the other group of 10 volunteers will rinse with placebo (10 mL for 30 seconds) 3 times a day for a duration of 14 days.
  • the burden for the volunteers that participate in the study is minimal. They will make 6 short visits to the site and the data for this study will be obtained by non-invasive samples of the mouth (saliva, tongue and interproximal plaque). The benefit for the volunteers will be the possible relieve of halitosis discomfort.
  • BM500 oral rinse for 14 days will be determined on the oral microbial activity related to halitosis such as proteolytic activity, the level of tongue coating and on oral malodour compared to placebo. Also, it will be determined how the BM500 oral rinse is experienced; the mouth feel (tolerance) will be examined using a VAS scale and compared with the placebo oral rinse.
  • Figure 5 provides a flow chart of the procedures that the subjects will undergo in the course of the research.
  • n > N ⁇ z 2 ⁇ p 1 ⁇ p z 2 ⁇ p 1 ⁇ p + N ⁇ 1 ⁇ F 2
  • the subjects will be randomly assigned to either the test group or the placebo group.
  • the treatment frequency, duration and volume of oral rinsing is identical in both groups.
  • Test group oral mouth rinse with BM500 3 times daily for a duration of 14 consecutive days. Each time the subject will rinse twice with 10 mL BM500 for 30 seconds (i.e. 14 days, 3x daily, 2x30 seconds with 2x10 mL).
  • Placebo group oral mouth rinse with placebo mouthwash 3 times daily for a duration of 14 consecutive days. Each time the subject will rinse twice with 10 mL placebo for 30 seconds (i.e. 14 days, 3x daily, 2x30 seconds with 2x10 mL).
  • BM500 will be used as a mouthwash/oral rinse. This oral rinse is considered a cosmetic product.
  • the product that will be tested in this study is BM500 based mouthwash.
  • the main study parameters are: Change in microbiota compared to baseline using 16S Next Generation Sequencing (NGS) microbiology for:
  • the secondary, exploratory outcome parameters are:
  • the subjects will be randomly be assigned to either the test or the control treatment group.
  • Approximately 200 of the pre-screened subjects are expected to be possible eligible after this pre-screening and will be invited to visit the clinic for an actual screening visit. Before the screening visit, these subjects will receive a written explanation of the background of the study, its objectives and involvement and they are asked to give their written informed consent.
  • a dental hygienist performs an oral examination, including organoleptic scoring (for procedure and method see appendix 9.1). If this score is 2 or higher, the subjects will be screened on all in- and exclusion criteria.
  • Interproximal plaque will be collected with unwaxed dental floss between two upper molars.
  • appendix 9.3 For the procedure and method see appendix 9.3.
  • Visit 2 Two days after the first visit, an additional baseline measurement will be performed Visit 2 (Day 0). During this the same assessments will be performed as described for Visit 1 (see also table below). In addition, the subjects will receive an explanation and instruction (on paper) on the use of oral rinse. Furthermore, the subjects will receive a diary to document the mouth rinse use and any adverse events. One day after this visit the subjects start using the BM500 mouth wash rinse or placebo for a period of 14 days. They are asked to start using the rinse from the morning of the next day (Day 1).
  • the subjects will visit the clinic another 4 times (i.e. once during the rinsing period and 3 times after the 14 day rinsing period): on Day 13, Day 15, Day 29 and Day 33. During these visits the same procedures as described for Visit 1 will be performed, including reporting of (S)AEs. Furthermore, during visit 4 and visit 5, the subjects are asked to describe their mouth feel using a VAS score.
  • Subjects can leave the study at any time for any reason if they wish to do so without any consequences.
  • the investigator can decide to withdraw a subject from the study for urgent medical reasons.
  • Moderate adverse events are classified as symptoms causing enough discomfort to interfere with usual activity and severe incapacitating event causing inability to work or perform usual activity.
  • the organoleptic score will be determined by a trained and calibrated judges who is trained by Dr. Saad (Bristol). Inter and intra examiner reproducibility data are resulted as a moderate agreement. The judge tested his ability to distinguish odours using the Smell Identification Test® (Sensonics Inc., Haddon Heights, NJ, USA) and to detect odours at low concentrations, using a series of dilutions of the following substances: skatole, putrescine, isovaleric acid and dimethyl disulphide (Doty et al. 1984).
  • Participants are instructed to close their mouth for 2 min, and then to slowly open their mouth at request of the examiner. Directly after opening the judge sniffs at a distance of approximately 3-5 cm from the nose of the examiner and the dorsum of the tongue of the subject. Subjects are instructed to breathe through the nose during the whole procedure.
  • Two sniffers independent asses consecutive and subjective organoleptic measurements, using an arbitrary 0-5 scale (Rosenberg et al. 1991a, Rosenberg et al. 1991b further modified by Greenman et al. 2004). (The mean of both scores represented the individual organoleptic score).
  • Stimulated saliva will be collected for microbiological analyses and proteolytic activity
  • Microbial DNA will be extracted (Kraneveld et al 2012). Samples will be processed for amplicon sequencing by barcoded masssequencing (Zaura et al, 2009). Data will be processed using dedicated bioinformatics pipeline installed at SARA (www.sara.nl). Microbial diversity analyses and phylogenetic profiles will be analyzed using both, OTU-based and phylogeny-based distance measures.
  • Saliva samples will be analyzed for protease activity using FRET technology. This will be performed by following the enzymatic cleavage of fluorogenic BikKam substrates specifically tailored for oral proteolytic bacteria using a fluorescence microplate-reader Kaman et al, 2014). Protein concentration measurements (Bradford-assay; Bradford, 1972) will be performed on these samples for standardization/calibration.
  • Interproximal plaque samples and tongue samples will be collected for microbiological analyses.
  • Interproximal plaque will be collected with unwaxed dental floss (Gerardu et al., 2007) between two upper molars. Mucosal swab samples will be collected from the tongue dorsum using a microbrush
  • a sample will be taken of the unrestored interproximal site between the first and second molar or the second and the third molar in one randomly chosen quadrant of the upper jaw. Plaque will be collected with unwaxed dental floss and will be removed from the floss by drawing it through a slit cut in the lid (Gerardu et al., 2007) of a labeled Eppendorf vial with 50 ⁇ l RNAProtect (QIAGEN, Hilden, Germany). Immediately thereafter the plaque will be spun down using a microcentrifuge and stored on ice until transport to the laboratory and then stored at - 80°C until further processing for DNA extraction.
  • Tongue mucosal swabs will be collected using a sterile microbrush (Microbrush International, Grafton, USA) by applying 4 strokes over the anterior two thirds of the tongue dorsum. Strokes will be made in an anterior-posterior direction. After the sample is taken, the tip of the microbrush will be placed into an Eppendorf vial with 50 ⁇ l RNAProtect solution and clipped off. Samples will be stored at -80 °C till molecular analyses at the microbiology laboratory.
  • Microbial DNA will be extracted (Kraneveld et al 2012). Samples will be processed for amplicon sequencing by barcoded masssequencing (Zaura et al, 2009). Data will be processed using dedicated bioinformatics pipeline installed at SARA (www.sara.nl). Microbial diversity analyses and phylogenetic profiles will be analyzed using both, OTU-based and phylogeny-based distance measures.
  • a portable gas chromatography (OralChroma®) using a flame photometric detector is the preferable method if precise measurements of specific gases are required.
  • This technology is specifically designed to digitally measure molecular levels of the three major VSC (H2S, CH3SH, and dimethyl sulfide CH3SCH3). It is accurate in measuring the sulphur components of the breath and displays each gas concentration in graph form via computer interface.
  • the volunteers are seated. The subjects are instructed to keep their mouth closed for 2 min and not to swallow, which allows sufficient build-up of VSC in the oral cavity.
  • the mouth is opened, after which the mouth is slightly opened. Subjects should breath through the nose while the mouth is closed. A sterile disposable syringe is inserted through this opening into the oral cavity. The subject needs to avoid touching the tip of the syringe with the tongue.
  • the piston is subsequently pulled to the very end of the syringe in order to fill the syringe with a breath sample from the oral cavity. The syringe is then removed from the oral cavity.
  • saliva is wiped from the tip of the syringe with tissue paper and a gas injection needle is set onto the tip of the syringe.
  • the piston of the syringe is slowly pushed to the 0.5 ml position.
  • the remaining breath sample is injected into the OralChroma® in one stroke. After 10 minutes the measurement is complete.
  • the VSC reading of the OralChroma® shows the concentration values of hydrogen sulphide, methyl mercaptan and dimethyl sulphide in ppb and ng/ml. These values are recorded separately and chromatograms are printed for analysis.
  • Two digital images of the tongue surface are taken. One from the tip of the tongue and one from the posterior aspect.
  • Tongue body color will be classified according the four typical tongue body colors (purple, pink, pale and red) (Yuen, 2002; Wang, David, 2001; Beaven, 1998).
  • the tongue is divided in 9 parts. From the vallate papillae to the tip i.e., back third, middle third and front third (according to Miyazaki et al. 1995). In addition from the left to the right i.e., left third, middle third and right third. For each of the 9 sections discoloration and coating is visually assessed.
  • the discoloration is scored on a scale from 0 to 4:
  • Tongue coating according to thickness
  • the thickness is scored from a scale from 0 to 2:
  • Light-thin-coating was scored when the pink color underneath is still visible through the coating. Heavy-thick coating is scored if no pink color can be observed under the coating. Each section of the tongue should be covered for more than 1/3 to obtain a score different than 0.

Claims (7)

  1. Composition d'hygiène buccale non diluée comprenant 20 à 80 % de nitrates dont au moins la moitié de la quantité de nitrates est constituée de nitrate de calcium, le reste des nitrates étant choisi parmi tout sel de cation pharmaceutiquement acceptable de celui-ci, 5 à 30 % d'UHP (urée-peroxyde d'hydrogène), 0 à 20 % d'urée, et de l'eau s'ajoutant jusqu'à 100 %.
  2. Composition d'hygiène buccale selon la revendication 1, comprenant 30 à 75 % de nitrates.
  3. Composition d'hygiène buccale selon la revendication 1, comprenant 40 à 70 % de nitrates.
  4. Composition d'hygiène buccale selon la revendication 1, comprenant 50 à 65 % de nitrates.
  5. Composition d'hygiène buccale selon la revendication 1, dans laquelle les autres nitrates comprennent au moins du nitrate d'ammonium et éventuellement du nitrate de potassium.
  6. Composition d'hygiène buccale diluée pouvant être obtenue par dilution d'une composition d'hygiène buccale non diluée selon l'une quelconque des revendications 1 à 5, dans lequel le facteur de dilution est choisi dans le groupe comprenant entre 1:1 et 1:10, entre 1:10 et 1:50, entre 1:50 et 1:100 et entre 1:100 et 1:1000.
  7. Composition d'hygiène buccale selon l'une quelconque des revendications 1 à 6 pour le traitement et/ou la prévention de l'halitose chez un humain ou un animal.
EP14777917.7A 2013-09-18 2014-09-18 Compositions d'hygiène buccale Not-in-force EP3046632B1 (fr)

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AU2014300493B2 (en) 2013-06-28 2020-01-16 Arjuna Natural Private Limited A medicinal composition of Amaranth extract origin having enriched nitrate content and a method of preparing the same
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